Healthcare practitioners generally know that the Department of Health & Human Services maintains a National Practitioner Data Bank (NPDB) into which various entities can place adverse action reports, reflecting the practitioner's wrongdoing. Healthcare practitioners are also generally aware that an adverse action report in their NPDB record could cause them serious trouble, even loss of a license or job. Beyond that, though, many healthcare practitioners don't think or worry much about their NPDB record. Everything changes, though, when you find that your NPDB record includes an inaccurate adverse action report that suddenly threatens your license, privileges, job, and career.
If you are a healthcare practitioner who has just discovered an inaccurate, out of date, or misleading adverse action report in your NPDB record, you should know that HHS regulations provide a procedure for requesting and requiring revision of an adverse action report. That procedure, though, can require skilled advocacy, sensitive communications with the reporting party and HHS Secretary, and adept navigation of administrative procedures. Retain the Lento Law Firm's premier Professional License Defense Team to help you obtain a revision of the inaccurate, misleading, or out of date adverse action report in your NPDB record. Call 888.535.3686 or complete this contact form now for our prompt and effective representation on NPDB adverse action report revision issues.
The National Practitioner Data Bank
The NPDB is a national clearinghouse for adverse action reports against healthcare practitioners. The NPDB protects patients from the small percentage of healthcare practitioners who commit malpractice, abuse, neglect, and other misconduct. HHS compiles and maintains the NPDB in an easily searched electronic database, allowing employers, hospitals, healthcare plans and programs, and state licensing boards to make comprehensive searches. The problem with the NPDB system, though, is the same problem with any other administrative system. NPDB output is only as reliable as its inputs, when the many adverse actions reports that individuals and entities file are often inaccurate, misleading, or out of date.
NPDB Adverse Action Reports
The quality and reliability of NPDB adverse action reports is the heart of the healthcare practitioner's NPDB problem. If adverse action reports were uniformly accurate, then healthcare practitioners would have no right to complain. But the following NPDB requirements introduce the probability of many errors in NPDB adverse action reporting.
Mandated NPDB Adverse Action Reporters
The first problem with NPDB adverse actions reports is that they rely solely on the many mandated reporters for their accuracy. No one checks the reports for accuracy unless someone, usually the severely impacted healthcare practitioner, notices and complains of the inaccurate report. The NPDB system is a little like flying an airplane without any inspections, relying on the airplane's crash to alert the airline to a maintenance problem. That's stupid, but that's the NPDB system. HHS regulations 45 CFR §§ 60.7 through 60.16 require the following individuals and entities to report adverse actions into the NPDB: insurance companies; boards of medical examiners; other state licensing or certification authorities; federal licensing and certification agencies; peer review organizations and private accreditation entities; healthcare entities; federal and state prosecutors; federal and state health plans; and federal government agencies and state law and fraud enforcement agencies. That's a lot of agencies and individuals, each using their own trained or untrained personnel, each making their own errors.
Mandated NPDB Adverse Action Reports
The second problem with NPDB adverse action reports is the wide variety of the mandated adverse action reports. So many different things get reported by so many different reporters that there are bound to be errors in the drafting, filing, interpretation, timeliness, and contents of adverse actions reports. HHS regulation 45 CFR 60.5 requires reports of the following matters: malpractice payments; licensure and certification actions; negative actions or findings; adverse actions; healthcare-related criminal convictions; healthcare-related civil judgments; exclusions from federal or state healthcare programs; and other adjudicated actions or decisions. Notice the ambiguity in some of these categories, especially adverse actions, negative findings, and healthcare-related crimes and judgments. For instance, is disorderly conduct or drunk driving a healthcare related crime? Is a civil judgment for breach of a compensation obligation in a professional partnership a healthcare-related judgment? These and other categories implicate substantial questions of what qualifies as a mandated adverse action report, how reporters should draft such reports, and how searchers should construe them.
Mandated NPDB Healthcare Practitioners
A third problem with NPDB adverse action reports is the wide variety of healthcare practitioners to whom they apply. HHS regulation 45 CFR 60.1 requires reports not only on physicians and dentists but also “other health care practitioners” and even “health care entities, providers, and suppliers.” The catch-all provision “other healthcare practitioners” covers any healthcare professional holding a state license, who may suffer license actions, malpractice settlements and judgments, or exclusion from reimbursement. If you are a licensed professional in a healthcare field, you are probably subject to NPDB adverse action reports. That wide variety creates substantial room for errors in adverse action reports.
NPDB Adverse Action Report Voluntary Revision
HHS regulation 45 CFR 60.21 provides that the NPDB will notify the healthcare practitioner who is the subject of a new adverse action report. The same provision then states that “the subject of the report or a designated representative may dispute the accuracy of a report concerning” the subject. The same provision later indicates that the aggrieved subject of the allegedly inaccurate report must approach the reporting entity with the request, more like a demand, that the reporting entity revise the report. Thus, the NPDB system does provide for adverse action report revision, although in its express terms, the provision only provides for voluntary revision at the agreement and action of the reporting entity.
How to Obtain NPDB Adverse Action Report Voluntary Revision
HHS regulation 45 CFR 60.21 describes the straightforward procedure for obtaining NPDB adverse action report voluntary revision. The aggrieved practitioner “attempt[s] to enter into discussion with the reporting entity to resolve the dispute.” In short, you ask the reporter to change the report. The regulation provides that if the reporter revises the report, the NPDB notifies the subject and all entities to whom the NPDB has sent the erroneous report. The process for voluntary adverse action report revision sounds simple. In practice, though, gaining voluntary revision is not so easy. You can ask, but the reporter can not only refuse. The reporter can even refuse to entertain or respond to your request.
How We Help with NPDB Adverse Action Report Voluntary Revision
If you get the cold shoulder from the reporter, or you know in advance that the reporter will refuse your requested revision, retain our attorneys to intercede and advocate on your behalf. We can use our diplomatic communication, advocacy, and negotiation skills to induce a more favorable response. We may, for instance, be able to show the reporter that although HHS regulation 45 CFR 60.22 grants immunity from civil liability for erroneous NPDB adverse action reports, the regulation withdraws the immunity if the reporter “has actual knowledge of the falsity of the information contained in the report.” Our advocacy may give the reporter the actual knowledge that the report is false. We may be able to convince the reporter that it faces defamation liability for all harm its false report causes you, so that it promptly withdraws or revises the erroneous report.
NPDB Adverse Action Report Involuntary Revision
HHS regulation 45 CFR 60.21 further describes the procedure for obtaining NPDB adverse action report involuntary revision. You must first give the reporter sixty days to respond. If no revision is forthcoming, you may then ask the HHS Secretary to review the report's accuracy. The regulation gives the Secretary thirty days to decide whether to revise the report, or more time on a showing of good cause. The reporter then has no say in the matter.
How We Help with NPDB Adverse Action Report Involuntary Revision
Our attorneys can help you with your request that the HHS Secretary determine that the report is indeed inaccurate and requires revision. HHS regulation 45 CFR 60.21 states that you “may provide a statement to the NPDB, either directly or through a designated representative that will permanently append the report.” This provision's implication is that the Secretary may not have the time, knowledge, skill, or willingness to make the actual revision. Instead, we would draft the proposed revision as part of our statement on your behalf. Our other presentation on your behalf would include the documentation and attestations necessary to convince the Secretary of the report's inaccuracy. The Secretary is likely to accept our compelling and well-documented advocacy, and simply adopt our proposed revision.
The Value of Our NPDB Advocacy
Don't attempt the above involuntary revision process on your own or with unqualified local criminal defense counsel. An effective presentation of your case for a revision of an allegedly inaccurate adverse action report effectively requires you to administratively establish in your favor the underlying question of your alleged misconduct. We can help you prove your underlying case. We know the kind of showing the HHS Secretary requires. We know how to research and write the explanatory brief, document every assertion in that brief, and prepare the revised report that the Secretary is likely to endorse and file. Our attorneys have substantial skill and experience in these kinds of administrative licensing matters. We know what an effective presentation takes. Our attorneys also have a national reputation and relationships that give the Secretary or Secretary's designee trust and confidence to adopt our recommended revision. Let us help you with your case for involuntary revision of the inaccurate NPDB adverse action report.
Why NPDB Adverse Action Reports Matter
The accuracy of your NPDB record matters because adverse action reports can have severe negative impacts on your healthcare license, privileges, employment, reimbursement, and career. Under HHS regulations CFR 45 CFR 60.17 and 60.18, HHS authorizes NPDB access for (1) state licensing boards, (2) employers of healthcare professionals, (3) hospitals offering practitioner privileges, (4) attorneys suing hospitals for malpractice, (5) law enforcement agencies conducting fraud and drug investigations, (6) utilization and peer review organizations, and (7) private health plans and public agencies administering healthcare programs. These are exactly the individuals and entities having the greatest control over your healthcare license, employment, privileges, reimbursement, and career. Your NPDB adverse action reports had better be accurate, or you could lose everything essential to your continued healthcare practice and career.
The Impact of Inaccurate NPDB Action Reports
To put it plainly, inaccurate NPDB adverse action reports could cost you any or all of the following losses:
- loss of your state license to practice your healthcare profession, when licensing officials use the inaccurate adverse action report to suspend or revoke your license;
- loss of your opportunity to obtain a new license in another state, when the inaccurate adverse action report causes that state's licensing officials to reject your application;
- loss of your hospital privileges, when hospital risk managers determine that your inaccurate adverse action report creates too great a malpractice liability risk to continue your privileges;
- loss of your healthcare employment, when your employer's managers determine that your inaccurate adverse action report creates too great of a risk that you will injure patients and create malpractice liability;
- loss of reimbursement for your services, when private health plan managers or public health program officials determine that your inaccurate adverse action report bars your plan or program participation;
- loss of professional references, recommendations, and support;
- loss of employment income and benefits, and impacts on your ability to maintain loan payments and other obligations; and
- impacts on your family's support and your mental and physical health and the welfare of your family members.
Premier NPDB Representation
If you face National Practitioner Data Bank issues requiring revision to an adverse action report, retain the Lento Law Firm's premier Professional License Defense Team to help you obtain the revision. Call 888.535.3686 or complete this contact form now for our highly qualified representation, for your best NPDB outcome.
